Hori Yasuhiro, Shibuya Kazutoshi
Department of Surgical Pathology, Toho University School of Medicine.
Med Mycol J. 2018;59(2):E31-E40. doi: 10.3314/mmj.18.004.
Echinocandins are antifungal agents that specifically inhibit the biosynthesis of 1,3-β-D-glucan, a major structural component of fungal cell walls. Echinocandins are recommended as first-line or alternative/salvage therapy for candidiasis and aspergillosis in antifungal guidelines of various countries. Resistance to echinocandins has been reported in recent years. The mechanism of echinocandin resistance involves amino acid substitutions in hot spot regions of the FKS gene product, the catalytic subunit of 1,3-β-D-glucan synthase. This resistance mechanism contributes to not only acquired resistance in Candida spp., but also inherent resistance in some pathogenic fungi. An understanding of the echinocandin resistance mechanism is important to develop both effective diagnosis and treatment options for echinocandin-resistant fungal diseases.
棘白菌素是一类抗真菌药物，可特异性抑制1,3-β-D-葡聚糖的生物合成，1,3-β-D-葡聚糖是真菌细胞壁的主要结构成分。在各国的抗真菌指南中，棘白菌素被推荐作为念珠菌病和曲霉病的一线治疗药物或替代/挽救治疗药物。近年来已有关于对棘白菌素耐药的报道。棘白菌素耐药机制涉及FKS基因产物（1,3-β-D-葡聚糖合酶的催化亚基）热点区域的氨基酸替换。这种耐药机制不仅导致念珠菌属获得性耐药，还导致一些致病真菌的固有耐药。了解棘白菌素耐药机制对于开发针对棘白菌素耐药真菌疾病的有效诊断和治疗方法至关重要。
